Preventive care for MPSERS Medicare members

Who is covered: Medicare members with certain risk factors for AAA

When: Once in a lifetime, with a referral from your doctor

Who is covered: All Medicare members

When: Annually

If you screen positive for alcohol misuse, you can get up to four in-person counseling visits per year (you must be alcohol free during counseling).

Who is covered: All Medicare members. If you've had Medicare Part B (Medical Insurance) for longer than 12 months, you can get a yearly "Wellness" visit to develop or update a personalized prevention plan based on your current health and risk factors. Advanced Care Planning is an optional preventive service at no cost to the member only when given with an AWV. When furnished not during the AWV a cost share would apply to the member.

When: Once per calendar year

Who is covered: Medicare members who are at risk of losing bone mass, risk of osteoporosis, glucocorticoid therapy for more than 3 months or primary hyperparathyroidism

When: Once every 24 months or more frequently if medically necessary

Who is covered: All female Medicare members

When: Breast exams: Every 24 months

Screening mammograms: One baseline at 35-39 years old, annually 40+

Who is covered: All Medicare beneficiaries without apparent signs or symptoms of cardiovascular disease

When: Annually

Who is covered: All Medicare members

When: Once every 5 years, when ordered by a doctor

Who is covered: All female Medicare members

When: Pap test & pelvic screenings: Every 2 years

Pap test annually if at high risk of cervical cancer or if you've had an abnormal Pap test within the past 3 years and are of childbearing age

Who is covered: All Medicare members age 50 and older, but there is no minimum age for having a covered screening colonoscopy.

When: Consult with your physician on the type of screening you need and the frequency (anywhere from 12-120 months): Guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), DNA based colorectal screening, flexible sigmoidoscopy, colonoscopy, barium enema, Cologuard

Who is covered: All Medicare members

When: Annually

Who is covered: Medicare members at risk or with pre-diabetes

When: Up to 2 tests per year with referral from your doctor

Who is covered: Medicare members with diabetes

When: As prescribed by your doctor

Frequency: Initial year: Up to 10 hours of initial training within a continuous 12-month period

Subsequent years: Up to 2 hours of follow-up training each calendar year after the initial 10 hours of training has been completed

Who is covered: Medicare members with diabetes or a family history of glaucoma, African-Americans age 50 or older, and Hispanic-Americans age 65 or older

When: Annually

Who is covered: Medicare covers HBV infection screenings if you meet certain conditions

When: Annually

Who is covered: Medicare members at high risk due to: Current or past history of illicit drug use, or blood transfusions prior to 1992, or born between 1945-1965

When: Once per lifetime, or annually for certain people at risk

Who is covered: All Medicare members between the ages of 15 and 65. Those at an increased risk less than age 15 or older than age 65.

When: Annually or up to 3 times during a pregnancy

Must be performed along with a pap test.

Who is covered: All asymptomatic female Medicare members 35-65 years old

When: Once every 5 years

COVID-19 shots

Who is covered: All people with Medicare

Details: Medicare covers FDA-authorized COVID-19 vaccines. For the latest information, visit the Priority Health COVID-19 vaccine information page.

Flu shots

Who is covered: All people with Medicare

When: Once each flu season

Pneumococcal shots

Who is covered: All people with Medicare

When: Most people only need one shot once in their lifetime. A different, second shot, is covered 11 months after you get the first shot. Talk with your doctor or other qualified health care provider to see if you need these shots.

Hepatitis B shots

Who is covered: Members who are at medium or high risk for Hepatitis B

When: Three shots are needed for complete protection. Check with your doctor about when to get these shots if you qualify to get them.

Who is covered: Medicare members who meet all of these criteria:

• Age 55-77
• Asymptomatic and do not have symptoms of lung cancer
• Current smoker/quit smoking in the last 15 years
• Have a tobacco smoking history of at least 30 "pack years" (average of 1 pack/day for 30 years)

When: Annually, when ordered by your doctor

Who is covered: Certain members who have a referral from their treating physician, diagnosed with diabetes or renal disease or who has had a kidney transplant within the last 36 months.

When: 3 hours of counseling the first year and 2 hours the following year(s). Services delivered by a registered dietician or nutrition professional.

Who is covered: Medicare members that could prevent or delay type 2 diabetes.

When: Once per lifetime

Who is covered: Medicare members with BMI greater than 30

When: Consult with your physician; Medicare covers behavioral therapy sessions to help you lose weight. 15-30 minute sessions (depending on individual or group counseling) may be covered if you get in a primary care setting (like a doctor's office), where it can be coordinated with your other care and a personalized prevention plan.

Who is covered: All male Medicare members age 50 or older

When: Annually for a digital rectal exam and prostate specific antigen (PSA) test.

Who is covered: Medicare members at increased risk for STIs, or pregnant women

When: Every 12 months, or at certain times during pregnancy

Who is covered: All Medicare members who use tobacco

When: Up to 8 visits in a 12-month period

Who is covered: All Medicare members

When: Within the first 12 months you have Medicare Part B